Organization
HARBOR DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENDA J POTTS RDA CDA (OFFICE MANAGER)
(269) 927-1313
Entity
Organization
Contact information
Practice address
143 E MAIN, BENTON HARBOR, MI 49022
(269) 927-1313
(269) 934-9447
Mailing address
143 E MAIN, BENTON HARBOR, MI 49022
(269) 927-1313
(269) 934-9447
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4545920
—
MI
Enumeration date
08/02/2006
Last updated
08/22/2020
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